This bulletin provides guidance to providers caring for NC Medicaid beneficiaries also enrolled in Marketplace coverage through HealthCare.gov.
Topics Related to Medicaid Managed Care
Standard Plans will begin to reimburse the APM rate for claims with a date of service on or after Aug. 1, 2024.
Providers need to submit new prior authorizations (PA) for services subject to 42 Code of Federal Regulations (CFR) Part II.
Effective Aug. 1, 2024, NC Medicaid will cover obesity management medications for beneficiaries 12 years of age and older.
Effective Aug. 1, 2024, over the counter oral contraceptive Opill will be available without a prescription, at no cost.
Effective Dec. 1, 2023, updates increased treatment visit limits for beneficiaries aged 21 and older. The home health ordering practitioner reference was also updated.
Effective June 1, 2024, CPT codes are newly eligible for coverage.
Providers should work with the Tailored Plans and Tailored Care Managers to support Medicaid beneficiaries transitioning to 1915(i) services.
AMH Provider Manual May 2024 reflects all program modifications and changes that impact provider contracts and operations.
This bulletin applies to NC Medicaid Managed Care Standard Plans.